HomeMy Public PortalAbout4833 DOREEN AVE_Building__ IISS��� i
71..... APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUH_D NG. CROSS ST.
DISTRICT NO. GROUP I TYPE PAQCESSED BY
FOR APPLICANT TO FILL IN Z!5r-v Sl I CONSr.
BUILDING11,, STATISTICAL CLASS IF I CATION I WER MAP
ADDRESS l N• E \( BK
CLASS. NO. DW ELL. UNITS --'
LOT NO!jj J y2 BLOCK MAP NUMBER i . HWYE YES 10
TRACT �tt(��f'7J , USE ZONE - SPECIAL `
SIZE OF LOT d L k 7 NO.OF NOW ON LOTS .II CONDITIONS
USEOF ••�� �T
EXISTING BLDG. ./Y W�-/-/-/ BUILDINGEXIST.
YARD HWV STREET NAME
�J TEL./ p �y SETBACK WIDTH
OWNER
Lf c- ,> NO.I(-yOZ�IL FRONT
ADDRESS SIDE
E
ARCHITECT OR TEL. P. L.
ENGINEER NO. INSPECTION RECORD
ADDRESSY
� O
CONTRACTOR VrT[) OPF1 NOYD / u
ADDRESS �3 Z� ,e,�aw; ' /lll�a/inr P/r. o.
DESCRIPTION OF WORK G.nl c-�F C�—��o�a r.y. _ w
NEW ADD i ALTER REPAIR DEMOLISH / / CC,,!/ /� �/ / Z
SO. FT. rr NO.OF NO.OF f�'WIL�.. 4fil"Le / iZ / �•,P o f
SIZE 1�Z�.7 /�.v� STORIES FAMILIES /
USE OF F///`//L� �OQ /�6-I .•Ci�'i�P GSif�+ �'I. /In-M.0
STRUCTURE i _ .�.�
rti[. 7"Vh/.YG�Y
SIGN
ATURE
/•'✓M L lL ?�('i[i
VALUATION$ U V
APPROVALS DATE INSPECTOR'S S1 IATURE
d FOUNDATION: LOCATIONNET
PMT.
FEE $ I I FEE $ FORMS. MATER ALS {'
FRAME: FIRE STOPS. 1 -q /-
HEREBY THAT
THE
THAT HAVE REND THIS APPLICATION BRACING. BOLTI A J�C�
AND STATE THAT THE ABOVE IE CORRECT AND AGREE TO COMPLY FURNACE: LOCATION.
WITH ALL COUNTY ORDINANCES LES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILD I
THE CONSTRUCTION. CERTIFY THAT IN THE PERFORMANCE
OF THE WORK EOR WHICH THIS PER S IS ISSUED SHALL NOT LATH, INT. A //
EMPLOY ANY PERSON IN ANY MANNER 50 A$ TO BECOME SU BU ECT
TO THE WORKMEN'S COMPENSATION LAWS OF CALIFORNIA._
SIGNATURE OF /� HOUSE NUMBER COR-
PERMITTEE ✓" L ( RECT AND POSTED
ADDRESS FINAL
CLYDE N. DIRLAM. PRINCIPAL STRUCTURAL ENGINEER
PERMIT CHECK VALIDATION CK. M.O. CASH PERT VALIDATION CJ M.G. CASH
L o 7 6`2 2 0' t4A`1' 2 5 1 D 15 .0 0 M
DEPARTMENT OF BUILDING AND SAFETY APPLICATIION FOR PERMIT
coukTy�&tn&ANGELES p N p{ y nm IS
"a4r WM. J. FOX, CHIEF ENGINEER R7P11Y 1 V E _y
U RLDN
FOR APPLICANT TO FILL IN_ " FOR OFFICE USE ONLY
/ ,/�j )h//5 /� J 1 DISTRICT NO. I --PL'AN'CK:NO; —PERMIT'NO:
BUILDNG
ADDRESS / D}-A �7 d/6 K p/C f,A r d V AL �/2 Z
LOCALITY '7 �..1`/� P� l.e e [ li 3 / °l✓��._- I J� ✓
{ I DATE ISSUED
f/AEN3D BY ��'� DATE O[A/PPL.
NEAREST LOWER A ..p t� S A J
CROSS ST. ll'' (� /`I fr \SII / 1
OWNER Jin A .S P. 1.0-1 (/ 6 Y ADDR'LDEING
SS � Sf !� R •C /7 NLIMAIL �I 1
ADDRESS N F'"� N r I r S T LOCALITY
/��f 1 //:/� n Ir A .(+( /� / NEAREST{ '•f • f
.CITY A F• / I A AA !-{ k AND. A 41 7� (f OR
OSSST.FIRE: Nb.or
ARCHITECT OR TEL - ZONE I PLANS TYPE q ,/�/ 6ROUPI��
ENGINEER NO.
BLDG. ' I ORD. NO.
ADDRESS
' � SETBACK4ILINE
PPROVft
tINOBYr ±� ..•..G.- -'I �f'�
-✓DATE
CONTRACTOR/ h{A J/7$ (k / APPBY{ DATEA00RES9r� 2-,-2 op Uf / USE ; I {
LEGAL ! CTIONS
DESCRIPTION TNO. W
f
/s /
TRACT (fs b�� �J �j .t •E
m NO. OF BLDG&
_SIZE OF LOT NOW ON LOT !'/ /// Ste. O V; /- C rlL���-G7�/c A, r
No. OF
EXISTING.BIDG. • FAMILIEUSE OF ROOMS
DESCRIPTION OF WORK
NEW ALTERATION ADDITION
0.4
REPAIR MOVING DEMOLISH O
SQ. FT. NO. OF /a. .. .. _.... .._.._.. C i J.1," .. .rl. _
SIZE [ S } RODMB w1 STORIES - / _ ,•_...WALL
ROOF
COVERING i 7-6d e- C COVERING L> A /VI
._ .-.. .. .... _.i:a.
USE OF
BUILDINGEW l� IA/F L l n/G .�-_ A I?A
LTJ � /� • /
l C 3> S nom,.,, 1/5� A - 4u.
9
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS. "
APPLICATION AND STATE THAT THE ABOVE IS CORRECT INSPECTOR DATE
ANDAGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATICN:;LOCATION
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FORMS, MATERIALS /'/�Y.� • ' �r
SIGNATURE OF FRAME: FIRESTOPS,
,{�r� N r'�. BRACING, BOLTS
PERMITTEE " ��;Ai'_
_LATH, INT.
AUTHORIZED AOT. '-' I T
LATH, EXT.
vswsaew-a P. C.B/ (� PLASTER, INT. - - ••
✓ -
FEE PLASTER, EXT. L
VALUATION FEE �" i' FINAL S, . .
I
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELESI L M �\tl G
WM. J. FOX, CHIEF ENGINEER tl
_ T FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDING LAp LI e/��n•/� DIST:r NO. PLAN CK.SSNO. �PERMIT
�NHOr.
EswDDR
LOCALITY REC0% DATE OF APPL. GSy
NEAREST X
CROSS 8T. BUILDING
ADDRESS /VQ ) 7 /vQ e v
'
(
MAIL • - t LOCALITY a
ADDRESS NEAREST
CITY TEL, � ST. J 4-J ✓—y�y
n,fANO. GpOFIRE
NO. OFI
NEERNGROHP-
ENGIARCHITECT
Q T'OR o' / BLDG. Pum ^ c� / I tqW NO.-
SETBACK LINESf-
ADDRESS/ APPROVED
TEL BY DATE
CONTRACTOR NO. / USE APPROVED
ZONE BY DATE
ADDR16SS \ `HOUSE NUMBERING
LEGAL
DESCRIPTION p BLOCK MAP NUMBER / D ( TF' FIELD CHECK BY
I LOT NO. p I ✓Iw J—
TRACT S NO. ASSIGNED BY
t NO. OF SLOGS. —�—CORRECTIONS ,o
1 SIZE OF LOT �,If'f /�,NO�W ON LOT h/ l �yv�.A-L�
EXISTING BLDG. ` &Al i I FAMIUSE OF LIES � (�1'I A/r15 //' � J /Y���� :/ -
DESCREPTION OF WORK i•
NEW I ` I ALTERATION I I ADDITION -
REPAIR I I DEMOLITION I I - -- - - F
SO. FT. �jJ O. OF 0
SIZE. BROOMS STORIES
EXT. WALL I V ROOF F
COVERING ( COVERING
USE OF STRUCT�i
Dq �
APPROVALS
INSPECTOR'S SIGNATURE DATE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION: LOCATION
CA - /
PLICATION AND STATE THAT THE INFORMATION GIVEN 18 FORMS, MATERIALS
CORRECT.
I AGREE TO COMPLY WITH 'THE CORRECTIONS LISTED FRAME: FIRE STOPS, IJ
E ,f� / S/
HEREON AND WITH ALL COUNTY ORDINANCES AND STATBRACING, BOLTS /
LAWS REGULATING BUILDING CONSTRUCTION.
FURNACE:
GAS VENT,DUCTISN vv
516NATUREOF /!/
PHRMITTEE LATH, INT, ti
v
ADDRESS
1/y
I v LATH, EXT.
AUTHORIZED AGI.
PLASTER, INT. //• 411 Alf,
TawaaaA• oBEa to-ap $ P. C. $ 1\j
(� O� FEE PLASTER, EXT. ' �'I
VALUATION ����_ FEE $ FINAL
I
.. . COUNTY OF.LOS'ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION • FOR APPLICANT TO FILL IN BUILDIN�` AE# // .fix J
I hereby-affirm that I have a certificate of consent to self,insure, BUILDING AD'
or
- - 'SS��GG :J �L/LQ'�
or a certificate of Workers' Compensation Insurance, or a certified, o
copy thereof (Sec.3800.lab. C) CIT—' 'C LOCALITY - -
Policy No.f� 0.37-y� Compan -
_ SIZE LOT - :NO.OF FLOOR.NOW ON LOT
E3 Certified Copy i5 hereby furnished. ' - NEAREST CROSS 5 i
❑.Certified copy is filed with the county building ins pection• -TRACT•" - BLOCK LOT NO, '
department. USE ZONE MAP NO.
✓Date2/-93 Applicant ASSESSOR'MAP BOOK PAGE" PARCEL' - -
SPECIAL CONDITIONS _
CERTIFICATE OF EMPTION FROM;WORKERS' �- ZJZ-1 TEL NO, S.Pill
COMPENSATION INSURANCE - '2. 6,- WITHIN 1000 FT OF SCHOOL? YES No _
(This,section need not be completed if the permit is for one hundred 'ADDRESS ADDRESSp' p `�
dollsrs.(S 100)or less.) ' �d 5_! ,7_ K..A�C Pl s� DISTRICT ROUP, TYPE CO ST: FIRE ZONE PROCESSED,BY
- -CITY. -_ ZIP _
I certify that indhe performance Of the work for which this permit. �7F6
is issued, I Shall not employ any person in any.manner so as to gRCHITEGT' R1. EENGINEER TEL NO. �J 0
heCOme Subject f0 fne Workers'Compensation Laws. STATISTICAL CLP IFICATION APT CONDO
Date Applicant ADDRESS • ' CLASS NO. �/ DWELL UNITS
NOTICE TO APPLICANT: If, after' making this Certificate Of _ _ REQUIRED TOTAL SETBACK FROM' EXIST
Exemption, ,you should become subject to the Workers CONTRACTOR TEL NO. - SET BACK L YARD HWY. PROP LINE WIDTH
Compensation provisions of the Labor Code you must forthwith' — 3 S— Z FRONT -
comply with such provisions or this permit shall be deemed revoked. q D, 5 LIC.No. P L _
LICENSED CONTRACTORS DECLARATION m 2 l_ G SIDE -
0 CITY LIC CLASS P L
I hereby affirm that I,am licensed.underprovisions of Chapter 9 r Ki e•� SEWER MAP
(commencing with Section7000)of Division 3 0f the Business and SO.FT.SIZE -NO.OF STORIES -NO.OF FAMILIES
Professions Code,and my license Is in full force a_nd effect. ej �' - NEW BK PG D a
License Num er �iq Lia Class /JJ q DESCRIPTION OF WORK O
.J oZ%% G ` �V /' ADD ❑ VALUATION^, ��-
' Contract l� -Date '8�a//9 f ALTER ❑. $ - V _—` U
' DI REPAIR ❑- $ - 'H0
❑ ]'am exempt untlpr ec. -
BAP.C.for this reason DEMOL ❑ - _ " - W
Q LOMA P/C p
Date: Z — / USE OF'A'D,1.G BLDG. S y•, URM .0
✓ Signature ' '{ - 1 z
APPLICANT•(PFINT TEL LDMA'Perm+ -- --- --- - +.•
❑ I; as oy g of the property,.or my employees with wages as • - - . - p
their, a compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section,7044, Business and FINAL DATEQ a�Lj? 133.[0 .
Professions Code.) - WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL - -
❑ I, as owner Of the property, am exclusl'ely ContraCfing With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE •FINAL BY '4j ITEMS
El
AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? 1 TGI lu7
licensed contractors to Code.)
the project{Section 7044, Q
Business and Professions Code.)
YES❑ ND❑ . TOTAL 133 _D"
-- WILL THE INTENDED USE MI THE BUIDILING BY THE APPLICANT OR FUTURE BUILDING `,[•/� - - 1,
OCCUPANT REQUIRE'A PERMIT FOR CONSTRUCTION D) EE PERMITTING
G CHECKLIST
SOUTH /�. (� ,l CHECK 133.V V
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT BCAOMD)SEE PERMITTING CHECKLIST FOR V}I/fit I I/J �1//•'
- - _ - GUIDELINES - s's��"'WWW ddd/C/ '�(�/Ilit:NANGE' .:...OU. . .
6 hereby.affirm that'there is a construction lending agency for YES❑ NO❑
a the performance of the work for which this permit is issued(Sec. mavE READ THE HAZARDOUSMATERIALS INFORMATION culOEANDTHa scaQMO PERMITTING3O9J, GIV,C.J CHECKLIST I UNDERSTAND MY REOUIREMENTS UNDER THE LOS ANGELES COUNTY CODE 0000-0001Q�),�Ol / 1/9
3
n' TITLE 2,CHAPTER 2.20 SECTIONS 220.100 THROUGH 2.20.140 CONCERNING HAZARDOUS i}
Lenders Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT.FROM THE SCAQMD.
a, Lender's AddressS� - 1 PM 12:00
o avx naoRACEVT 7.4'V
o I certify'that I have read this application and slate under penalty
4 of'perjury that the above information is'CDrrect..l agree to comply PC.FEE PERMIT FEE
with all county ordinances and State laws relating to building
m construction, and hereby authorize representatives of this County ISSUANCE FEE n �I
to enter upon the above-mentioned property for inspection purposes. rJF
�wumre m roo�om o� : oe.,
INVESTIGATION FEE TOTAL FEE/3
t SEE REVERSE FOR EXPLANATORY LANGUAGE
COUNTY OF LOS ANGELES TEMPLE =;T•, # u ":G !<I niD NG PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAST-RATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMFNI TEMPLE CITY CA 1+1780 H;. 0508 0409140044
PHONE: (626) 255-0488 EXT:
LECAL ID: r h0. OF CONSTBUI LC II:G '^CRESS: �—
ITR: 13645 LT: 47 BL: .001 SQ. FT STORIES TYPE 4833 DOREEN. AV
__, S?RUCTIIRE: VN TEMP CA 91730414^
^SSESSOR INFORMATION NUMBE3: I NEAREST CROSS STREET: LOWER AZUSA
8585-024-033 T40MAS PAGE; 597 GRID: C5 LOCALITY: TEMPLE CITY, C
TENANT: ---(EXIST BLDG USE: RESID USE ZON P.- ISSUED ON: PROCESSED BY: EXPIP.'S N
(EXIST CCC GRP: 09/14/04 JK 09/09/05
UWNER; TEL N0: �IHLDGS. NOW ON LOT: -- AL/ UATIUN: FINAL DATE I nL Y:
SHILEY MAXWELL R;MARIE TRS SFIUEY TRU (818) 448-Y50Z- ,SC•0� _�2- �- _
4833 DOREEN AV
(TEMP 917804140 FEES PAID DESCRIPTION F WU^K
ADD ROOF OVER 6s•"_P. ' .,JR
FEE DESCRIPTION: vUANTITY: UOM: AMOUNT:
APPLICANT: TEL. NO:
'SAME AS OWNER AA BLDG PERMIT ISSOARCEi.75
IAC STRONG MOTION RESID 1500.00 VAL U.50 ISP ECTAL CONDIilU.NSo
L01 PLANCHECK W/O EN-HC 1500.00 VAL 32.11
D2 PERMIT W/0 EN-w-- 1500.00 VAL 82.20
TOTAL FEES 192.56
CONTRACTOR: —'TEL. N:,: f,1FrROV4
LS OFT INS.^ CT ;' SI G;nTl�1RE
ISAME AS 6NNER -
LIC. NO ILO CAT ION AND SETBSf.:KST—�
LSOILS ENGINEER a?P0�'AL I
ARCHITECT OR ENGIREOR: `-- TEL. N0: FGU( NC•A71 ON/1'n E':CH FORMS i-—_ __---R
--,.. "'i0: 'SL.",B^,G—/UNDER FLCL'R
I IR:''i ScD FLCCR r�:: i?r--•— �— �—
_
hiA?N9i SEWER MP.P GUGKo PAU:—_—`IRE ZCN'c:--_Cis%':'
XX 3 G3
N0. OF FAMILIES: DWELLING liAf•i
4l S; /CONDI STAT LASS FL OWAR SHEAT HI NcI
NO 21 Ik00F— —HE
SHEATH_ING
SCHOOL WITHIN HAZARDOUS SHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FRAME INSPECTION —`—
REQUIRED TOTAL SETBACK FROM EXIST TIRE SPRINKLER HANI ER—
SET BACK YARD: HWY: PROP LINE: WIDTH:
(FRONT PL- I INSULATION/WEATHER S. .TPS
SIDE PL-
____- INTERIOR LATni LSI: .AILL
ly i ELTE3IOR LATH
RATED FLOOR/Cti, A.SS iv,
RATEDWALL
SHAFTS/OP "JI'JGS -I
T-BAR CEILINGS _
LOT DRAINAGE
(REPORT I0: DPR261 ROUTE TO: BS050B --
COUNTY OF LOS ANGELES TEMPLE CITY 0 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0605090010
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST BUILDING ADDRESS:
TR: 13645 LT: 47 BL: .001 SQ. FT STORIES TYPE - 4833 DOREEN AV
STRUCTURE: 50 VN TEMP CA 917804140
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
8585-024-033 THOMAS PAGE: 597 GRID: C5 LOCALITY: TEMPLE CITY, C
TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 05/09/06 JK 05/04/07
OWNER: TEL. N0: BLDGS. NOW ON LOT: VALUATION: FINAL IDA FINAL BY:Y: CODE:
SHUEY MAXWELL R;MAR ZE TRS SHUEY TRU (626) 448-2502- 4,500
4833 DOREEN AV
TEMP 917804140 FEES PAID DESC IP ION OF WORK
PAT COVER 5'X10' W/DECORATIVE BRICK STONE
FEE DESCRIPTION: QUANTITY: DOM: AMOUNT:
APPLICANT: TEL. NO:
WIGHTMAN (909) 732-9344- AA BLDG PERMIT ISSUANCE 27.75
1965 9TH ST. AC STRONG MOTION REBID 4500.00 VAL 0.50 SPECIAL CONDITIONS:
LA VERNE, CA 91750 AX BUILDING REVIEW FEE 54.70
D2 PERMIT W/O EN-HC 4500.00 VAL 132.60
TOTAL FEES 215.55
CONTRACTOR: TEL. NO: _ APPROVALS DATE INSPECTOR SIGNATURE
RICHARD WIGHTMAN (909) 732-9344-
1965 9TH ST LIC. NO LOCATION AND SETBACKS
LA VERNE CA 91750 823954 B
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS i
- C
LSC. N0: SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION
XX 3 01
FLOOR. SHEATHING
NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS:
NO 21 ROOF SHEATHING
SCHOOL WITHIN BAZARDOUS SHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FRAME INSPECTION
REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL- INSULATION/WEATHER STRIP
SIDE PL-
INTERIOR LATH/DRYWALL
EXTERIOR LATH
RATED FLOOR/CEIL ASSEM.
RATED WALL ASSEMBLIES
RATED SHAPTS/OPENINGS
T-BA.R CEILINGS
LOT DRAINAGE
REPORT ID: DPR261 ROUTE TO: BS0508